Guidance regarding COVID‐19 for survivors of childhood, adolescent, and young adult cancer: A statement from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Abstract

Childhood, adolescent, and young adult (CAYA) cancer survivors may be at risk for a severe course of COVID-19. Little is known about the clinical course of COVID-19 in CAYA cancer survivors, or if additional preventive measures are warranted. We established a working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) to summarize existing evidence and worldwide recommendations regarding evidence about factors/conditions associated with risk for a severe course of COVID-19 in CAYA cancer survivors, and to develop a consensus statement to provide guidance for healthcare practitioners and CAYA cancer survivors regarding COVID-19.

Impacts of COVID‐19 on caregivers of childhood cancer survivors

“…However, there are scarce data on this topic in survivors of childhood cancer (CCS), who frequently have multiple treatment‐related chronic conditions, including cardiovascular disease, diabetes, and reduced immune function, 24–28 and who are at increased risk of both infection and postinfection complications relative to the general population 29,30 . While evidence from a cohort of 281 CCS in New York City observed low overall rates of infection and hospitalization, 31 the financial and psychosocial impacts of COVID‐19 in CCS and their caregivers remains poorly described 32 . This presents challenges for communicating risks to caregivers and to coordinating surveillance and follow‐up care in this vulnerable population.…”

COVID‐19 in pediatric survivors of childhood cancer and hematopoietic cell transplantation from a single center in New York City

“…The coronavirus disease 2019 (COVID‐19) pandemic has unique implications for the growing cohort of survivors of childhood cancer and hematopoietic cell transplantation (HCT) for nonmalignant hematologic/immune disorders, 1,2 referred to herein as “survivors.” Investigators have postulated that history of underlying immune dysfunction and/or organ injury due to prior therapeutic exposures increase survivors’ risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and/or increased severity of COVID‐19 3–5 . Using the Childhood Cancer Survivor Study (CCSS) cohort, Perkins et al previously found an increased incidence of overall infections and a higher risk of infection‐related mortality among survivors of childhood cancer as compared to unaffected siblings for at least 35 years after therapy 6 .…”

“…Using the Childhood Cancer Survivor Study (CCSS) cohort, Perkins et al previously found an increased incidence of overall infections and a higher risk of infection‐related mortality among survivors of childhood cancer as compared to unaffected siblings for at least 35 years after therapy 6 . Whether these infectious risk findings can be applied to the COVID‐19 pandemic and inform guidelines for childhood cancer survivors as they return to school or work is unknown 5,7 . In an effort to fill this gap, we assessed reported COVID‐19 symptoms, exposures, and/or hospitalization, as well as SARS‐CoV‐2 IgG status, in a cohort of pediatric survivors presenting for routine long‐term follow‐up (LTFU) either in‐person or virtually in the early months of the COVID‐19 pandemic in New York City, one of the original epicenters of the pandemic.…”

“…Investigators have postulated that history of underlying immune dysfunction and/or organ injury due to prior therapeutic exposures increase survivors' risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or increased severity of COVID-19. [3][4][5] Using therapy. 6 Whether these infectious risk findings can be applied to the COVID-19 pandemic and inform guidelines for childhood cancer survivors as they return to school or work is unknown.…”

“…6 Whether these infectious risk findings can be applied to the COVID-19 pandemic and inform guidelines for childhood cancer survivors as they return to school or work is unknown. 5,7 In an effort to fill this gap, we assessed reported COVID-19 symptoms, exposures, and/or hospitalization, as well as SARS-CoV-2 IgG status, in a cohort of pediatric survivors presenting for routine long-term follow-up (LTFU) either in-person or virtually in the early months of the COVID-19 pandemic in New York City, one of the original epicenters of the pandemic.…”